End-stage cancer patients and their physicians may opt for chemotherapy because they think it will relieve discomfort or prolong life. However, in a new study of adult cancer patients with less than six months to live, most patients did not benefit from end-of-life chemotherapy, and surprisingly, the patients who were functioning the best at baseline were given the lowest quality-of-life scores in the last week of life. What's more, chemotherapy didn't improve survival time.

At six U.S. oncology clinics, 312 cancer patients (mean age, 58.6 years) with solid tumors that had metastasized participated in the study. Their performance status (how well they were functioning) was assessed at baseline. About half were receiving end-stage chemotherapy at enrollment. After death, their closest caregiver was asked to rate the patient's overall quality of life and physical and psychological distress in the week before death, and the scores were combined to form a "quality of life near death" (QOD) score.

Most strikingly, the 122 patients who were in the second healthiest group ("restricted in physically strenuous activity but ambulatory and able to perform light work") fared worse after chemotherapy than sicker patients-more than half were given significantly lower QOD scores in the last week. The authors surmise that the toxicity of chemotherapy may reduce well-being more dramatically in people who feel better before treatment than in those who are already functioning at a low level.

"I've heard from many nurses that having data that show that chemotherapy is unlikely to benefit patients or even harm them, empowers and informs" them when they're making end-of-life decisions, said study leader Holly Prigerson, professor of sociology in medicine at Weill Cornell Medical College in New York City. However, the use of end-of-life chemotherapy remains a personal choice. Patients and their families should ask about likely adverse effects and how much additional time might be gained from further chemotherapy, suggested Prigerson.

If an oncologist suspects the death of a patient will occur within the next six months, providing no active treatment may be the best course, suggests an accompanying editorial. It could reduce the suffering that cancer patients and families endure at the end of life.-Carol Potera

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